Let’s begin by stating the obvious; The US is not doing enough cannabis research. There is a small body of studies and a myriad of anecdotal evidence that THC and CBD molecules can help our bodies and minds. Unfortunately, it is proving difficult for researchers to garner support for large trials that might have the power to change minds in mainstream medicine. Without the evidence, guidelines and standards of practice can’t change.
One of the big reasons for resistance towards cannabis from the medical community is precise dosing. Precision is crucial in medical treatment. Without it, apprehension from physicians whose licenses are on this line is understandable. Some vaporizers boast accurate dose control, but given the shaky track-record in lung safety, they’re unlikely to be a pharmaceutical candidate. Edible methods such as tablets, tinctures or sweets may provide consistent dosing, unfortunately there is enormous variation from person to person in how our GI tracts process the cannabinoids. One new inhalation device, however, offers precision dosing without heating the contents, and without the gamble of the digestive system.
THC inhalers ensure accurate metered doses, making them promising candidates for therapeutic use. Pressure suspends the canister’s contents into tiny aerosolized droplets that are easily inhaled. Absorption in the upper and lower respiratory tracts is dependably rapid. The mouth, throat, and lungs are all areas of quick medicine delivery. In the pain-management setting, it’s important to stay ahead of pain with long-acting agents, but also have something fast-acting for breakthrough pain.
Israel has been proactive in putting these new devices to the test for just that purpose. Israeli medical researchers published two compelling papers in recent months that investigate the use of these smokeless-inhalation devices for pain patients. In March 2020 a small preliminary trial in the Journal of Cannabis Research by Ben-Ishay, O., et al, produced some simple but groundbreaking evidence. The researchers merely needed to confirm that the blood levels of THC responded as expected from the inhalation and that there were no concerning side effects. Both outcomes were excellent, allowing scientists to move forward and study the device’s effect on pain.
Next, in an exciting study published May, 2020 in the European Journal of Pain, S. Almog, et al., put THC inhalers to the test on multiple levels. In a double-blinded, randomized and placebo-controlled trial, they measured the effect on pain, cognitive performance, the drug’s movement through the body and the safety at therapeutic doses for 27 chronic pain patients. Compared to placebo, patients reported a significant decrease in pain with a small as 1mg doses. They found that the effects were dose-dependent, reproducible and safe. The medical community desperately needs precisely this sort of evidence. The conclusion of this well conducted trial opens the door for THC inhalers to enter the pharmacological cannabis space. Larger studies will follow and with similarly positive outcomes, they will begin to alleviate physician fears and encourage pharmaceutical companies to develop more FDA approved THC medications.
With the period of vast over-prescribing of opioid painkillers still haunting us here in the US, we need to be more open to safe alternatives. Our medical providers desperately need more prescribable cannabis. Hopefully, with forward-thinking researchers conducting the sort of solid research we see here, we are approaching a watershed moment for cannabis.
Several companies in the US make cannabis inhalers. NFuzed, a company selling their easy to use THC inhaler in California, offers a simple but pharmaceutical grade version. Each puff delivers 5mg of THC distillate. The other ingredients are a coconut oil derivative and the same propellant that is used in asthma inhalers. Consumers control dosing by starting with 5mg, which is adequate for many, and adding as needed. Heavier users can inhale a second puff to enhance the experience. Because of the fast onset, anyone can easily extend their high with another puff as the first effects wane.
With the steady growth of the cannabis industry, the essential designation during the covid-19 pandemic and these benchmark trials, we move ever closer to acceptance in the mainstream. With this progress, we can anticipate the medical community embracing cannabis for its numerous health benefits. As long as we continue to have creative and ingenuitive people in our community applying solid science to the use of this magical plant, the future looks bright.
Ben-Ishay, O., Bar-On, O. & Kluger, Y. Smokeless consumption of medical cannabis pharmacokinetics, safety and feasibility of the CannaHALER© a phase 1a study. J Cannabis Res 2, 15 (2020). https://doi.org/10.1186/s42238-020-00022-4
Almog, S., Aharon‐Peretz, J., Vulfsons, S., Ogintz, M., Abalia, H., Lupo, T., Hayon, Y. and Eisenberg, E. (2020), The Pharmacokinetics, Efficacy, and Safety of a Novel Selective‐Dose Cannabis Inhaler in Patients with Chronic Pain: A Randomized, Double‐Blinded, Placebo‐Controlled Trial. Eur J Pain. Accepted Author Manuscript. doi:10.1002/ejp.1605